Can the Ketogenic Diet Treat Depression and Anxiety, Even Schizophrenia?

April 18, 2018

Mental illnesses range in severity from mildly inconvenient to completely debilitating. Unfortunately, no matter the level, there are few ways to effectively treat many psychiatric disorders, especially schizophrenia — the disease that’s been a common topic for filmmakers and authors as the pinnacle of crippling insanity.

However, research has begun slowly leaning toward a possible breakthrough. What if I told you that there may be a schizophrenia natural treatment that involves no supplements, psychotropic drugs or side effects? In fact, this schizophrenia natural remedy might reverse common side effects associated with antipsychotic medications such as weight gain and insulin resistance.

It might sound crazy, but I’m talking about the ketogenic diet for schizophrenia. Yes, the high-fat, low-carb keto diet may be a solution for millions of people suffering from a disease currently treated with partially effective medications with dangerous side effects. In addition, this diet has shown promise treating a variety of other mental and brain disorders, including manic depression, major depressive disorder, anxiety, autism and ADHD.

First, let’s look at a few common mental disorders and their features. Then, I’ll walk you through some of the current issues facing the mental health community before we dive into the scientific evidence that suggests the ketogenic diet treats schizophrenia and other mental illnesses.

Quick Overview of Certain Mental Disorders

Schizophrenia

Schizophrenia is a psychotic disorder typically treated with both drugs and psychotherapy. It’s sometimes confused with delusional disorder, but someone who has other diagnostic symptoms of schizophrenia can’t be diagnosed with delusional disorder because delusions can also be a symptom of schizophrenia. (1)

Individuals with schizophrenia may suffer from a number of symptoms that fit into three different groups: negative, cognitive and positive. Negative symptoms include things such as a “flat affect” (little to no emotional expression in the voice or face), an inability to experience pleasure and difficulty starting or completing a new activity. Cognitive symptoms might be issues with “executive functioning” (which is defined as a problem understanding information or making decisions based on that information), issues with attention/focus or bad short-term memory use.

The “positive” symptoms of schizophrenia are the ones we usually associate with the disease: hallucinations, delusions, dysfunctional thinking patterns and unusual bodily movement. (2)

Schizophrenia is frequently genetic and has several common biological markers and/or risk factors, such as multiple gene encoding errors or malfunctions, smaller total brain matter, disrupted immune system function and white matter abnormalities. (3, 4, 5, 6, 7) It affects men and women equally, but men tend to present symptoms earlier. Schizophrenia onset happens almost always in late adolescence to the early 20s, but the potential ages at time of diagnosis range from 12–40 years of age.

While there can be environmental factors influencing the first time symptoms become obvious, it seems the underlying cause of schizophrenia is usually biological.

Depression and Anxiety

Depression and anxiety are mood disorders experienced by a large number of people. They can be experienced by the same person and are conventionally treated with individual medications, psychotherapy and/or counseling.

Both of these conditions are thought to have both external and internal causes, such as trauma/stress, dietary habits, excessive alcohol intake, substance abuse, mold or heavy metal toxicity, genetic disruption, thyroid issues, hormone imbalances, medical conditions, certain medications, damage to neurotransmitter systems and others.

Common anxiety symptoms include muscle tension, tightness of the chest, heart palpitations, high blood pressure, insomnia, digestive issues, panic attacks, irritability, focus problems, restlessness, sweating, anxiousness and an inability to socialize.

Someone showing signs of depression will experience some or all of the following: fatigue, worthless or hopeless feelings, concentration problems, sleep disturbances, restlessness, loss of interest in normal activities, changes in appetite, chronic aches, digestive issues, anxiety, sexual dysfunction and thoughts of suicide.

It’s important to note that depression is not caused by a simple chemical imbalance. This theory has been debunked by researchers over the last half-century or so, but unfortunately still exists as a major marketing scheme to both consumers and physicians. (8, 10) It matters because this theory is ultimately damaging to the people who believe it because it decreases the empowerment these patients feel and, in turn, affects their perceived ability to improve their symptoms. (11)

The Problems with Conventional Treatment for Mental Disorders

Isn’t the way doctors and psychiatrists treat mental illness the best we can do? Shouldn’t I just take medication if I have a mood or psychotic disorder? Why would my doctor prescribe this to me if there were better options, or if this medication was dangerous?

These are very real questions asked by people every day, and they deserve full answers. While I have more thoroughly discussed the dangers of psychoactive drugs in another piece, I’ll give you some of the major points to remember when considering these mind- and body-altering drugs for yourself or your loved ones.

Psychoactive drugs aren’t as effective as you may think.

Antidepressants, for example, may only be effective about 10–20 percent of the time when you factor in the placebo effect. (12) That’s not impressive, to say the least. In addition, at least one review of antidepressants and their efficacy came to the conclusion that it’s not possible to be sure if antidepressants actually work because of how often researchers and psychiatrists fail to submit clinical trials when results aren’t in favor of antidepressants. (13)

When it comes to antipsychotic drugs (also called neuroleptics), the results are equally troubling. The average layperson would likely tell you that these medications are the only way schizophrenics can have some relief from their hallucinations, delusions and other symptoms — and yet, they may actually prolong the need for external care. In fact, methods such as The Soteria Paradigm have seen major improvements with little to no use of psychotropic drugs, finding that schizophrenic patients may respond better, in the long-term, to a low- or no-drug approach. (14, 15)

The side effects and other dangers of psychoactive drugs are very serious.

All medications come with side effects. In the case of psychoactive drugs, that list includes reactions like suicidal thoughts, weight gain or loss, tardive dyskinesia (stiff, uncontrollable jerks in your face or body), dangerously low blood pressure, a sluggish “walking through concrete” feeling (particularly with antipsychotics) and many others. (16, 17, 18, 19, 20)

However, it’s not just side effects you should consider. In addition to a very pronounced risk of suicidal thoughts, various psychotropic drugs are associated with the following dangers:

Heart problems (21)
Pregnancy and birth complications (22, 23, 24)
Violent behavior (25, 26, 27)
Worsened mental illness (28, 29)
Car accidents (30, 31, 32)
Poor immune function (33)
Drug abuse/addiction (34, 16)
Sexual dysfunction (35, 36)
Elevated risk of breast cancer (37, 38)
Diabetes (39, 40)

Scientists have studied many natural or alternative methods to treat mental illness that seem to work effectively.

While many in the traditional medical field may scoff at the idea, natural remedies for schizophrenia, depression, anxiety, OCD, ADHD and other mental illnesses do exist, and they may actually work as or more effectively than the conventional drug treatments used.

Often, a traditional MD has never been taught or educated on how these alternatives have been known to improve symptoms of mental illness, which is just one of many reasons to be an advocate for your own health.

Some of the most researched healthy natural alternatives to psychotropic drugs include:

Eating a healthy, well-balanced diet, particularly high in omega-3s, healthy fats, probiotics, fruits and vegetables (41, 43)
Reaping the benefits of exercise (44, 45, 46)
Therapies like cognitive-behavioral therapy (CBT), emotional freedom techniques (EFTs) and acceptance and commitment therapy (ACT) (47, 48, 49, 50)
The Soteria Paradigm or similar models, which are schizophrenia natural treatments (or for other psychotic disorders) involving community-based therapy (51, 52, 53)
Dietary supplements including omega-3s, vitamin D, St. John’s wort, Traditional Chinese Medicine remedies, L-lysine and L-arginine, exogenous ketones and inositol (see my “Natural Alternatives” piece for more detailed information)
Essential oils lavender, roman chamomile, orange and lemongrass (54, 55, 56, 57)

Can the Ketogenic Diet Treat Schizophrenia, Anxiety & Depression?

With that introduction, I want to share with you some of the current science behind the incredible brain-boosting benefits of the ketogenic diet for mental disorders. This idea began with a few case studies.

The Ketogenic Diet and Schizophrenia

A 70-year-old woman, referred to in the scientific literature as C.D., was diagnosed with schizophrenia at 17 years of age. According to her own recollections, she suffered hallucinations of some kind nearly every day since the age of seven. In the five years prior to this visit, C.D. had been hospitalized six times for worsening symptoms of psychosis and multiple suicide attempts, and was taking six strong psychotropic medications all at once. In addition to schizophrenia, C.D. was diagnosed with obesity, obstructive sleep apnea, GERD, incontinence and glaucoma. She was on an additional seven medications each day for these various other disorders.

Her doctor suggested she try following a high fat, very low-carbohydrate dietary regimen (no more than 20 grams of carbs per day). At a follow-up 19 days later, she informed her physician she was no longer having the hallucinations that had plagued her for 63 years — they stopped after eight days on this ketogenic diet for schizophrenia.

This case study reports 12 months worth of follow-up care, in which C.D. had no auditory or visual hallucinations and lost 30 pounds, even when going off the diet for several days at a time at two or three points throughout the year. (58)

Another report, this one by Harvard psychiatrist Dr. Chris Palmer, shares two instances of patients whose symptoms improved while on a ketogenic diet. The first patient, a 31-year-old female, was diagnosed with schizoaffective disorder at the age of 23. Schizoaffective disorder is classified when a person has both symptoms of psychosis (hallucinations, delusions, etc.) and struggles with severe bouts of mood disorders like depression or mania.

Palmer’s female patient had been on trials with 12 total medications, even clozapine (the last resort for most doctors due to its substantial side effects) and undergone 23 rounds of electroconvulsive therapy (ECT — formerly “electroshock therapy”) when he recommended a ketogenic diet. Four weeks later, she had lost 10 pounds and suffered none of her former delusions. In four months, she was down 30 pounds overall and, much more impressively, dropped a massive 37 points on the PANSS scale, a method used by psychiatrists to rank the negative and positive symptoms of psychotic disorders.

Patient number two in this review, a 33-year-old man, began a ketogenic diet for weight loss after topping out at 322 pounds. This patient had also been diagnosed with schizoaffective disorder 14 years previously and had tried 17 medications, including clozapine, with little to no result. Not only did he lose weight fast (104 pounds in a year), but he had a “dramatic” decrease in the symptoms of schizophrenia he’d previously experienced, dropped an astounding 49 points on the PANSS scale and was able to begin dating and take college courses.

Each of Palmer’s patients found that symptoms returned after going off the diet for a significant period of time, but then went away again when they started eating keto diet foods again. (59, 60)

A review published in 2017 recounted the use of the ketogenic diet in a large number of psychiatric disorders including schizophrenia. They share a small, uncontrolled study in 10 women completed in 1965 (before the dawn of modern antipsychotic drugs) in which all of the women experienced “statistically significant decrease in symptomatology” after two weeks on a ketogenic diet. (61)

After results like these, researchers have begun to focus on moving forward to test the ketogenic diet as one of the schizophrenia natural remedies. This new wave has begun with an research study released in 2015. The animals on the keto diet in this study all weighed less than those on the standard (control) diet, and all experienced a decrease in “pathological behaviors” common to this model of schizophrenia. (62)

In a press release about this study, one of the researchers (Dr. Sarnyai) commented on one of the most impressive parts of the ketogenic diet and schizophrenia in this study:

It’s another advantage that it works against the weight gain, cardiovascular issues and type-two diabetes we see as common side-effects of drugs given to control schizophrenia.

Moving forward, these scientists plan to conduct additional animal studies as well as designing human clinical trials. (63)

So, we’ve arrived at one question we started with: Can the ketogenic diet treat schizophrenia? Our answer, for now, is that there are some incredibly promising results that suggests it may be able to do just that, at least in some patients. I’m hoping for more positive results as researchers explore the relationship between the ketogenic diet and psychosis.

The Ketogenic Diet and Anxiety

When it comes to anxiety, the ketogenic diet hasn’t been studied extensively. However, a few relevant studies have shown promise in this area.

A research study published in 2016 found that inducing ketosis by giving rats exogenous ketone supplements “reduced anxiety-related behavior.” They suggest more research be done, as their results indicate that ketone supplements may be a possible method for quelling anxiety via ketosis. (64)

Another animal-based study found that feeding pregnant mice a ketogenic diet resulted in lowered risks for depressive and anxious behavior in the offspring of those mice. (65) The ketogenic diet for pregnancy has not been extensively researched in humans, though, so if you are pregnant or thinking of becoming pregnant, consult your OB-GYN before beginning any new dietary regimen.

The Ketogenic Diet and Depression

Interestingly, depression and epilepsy are connected. Because of this apparent correlation, researchers have begun to wonder if the keto diet may be beneficial for depression, since it so effectively manages symptoms of epilepsy. (66, 67)

No human trials have been completed, and animal research may not always translate to humans. However, as I stated above, mice born to mothers on a ketogenic diet seemed less likely to develop symptoms of depression in one research study. (65)

In addition, another controlled study, this time in rats, found that depressed rats on the ketogenic diet were more mobile than their counterparts, a sign that the diet had an antidepressant effect. (68)

What about other disorders, like manic depression, autism or ADHD?

There is evidence that the ketogenic diet and mental disorders go even further, with potential applications in manic depression, autism and even ADHD.

Similarly to many of the schizophrenia reports, records of the ketogenic diet for manic depression are mostly case studies. In one case study, two female patients remained in ketosis for years (one patient for two years, the other for three). Both reported their moods stabilized while on the diet in a way that exceeded their prescription medication and experienced little to no side effects. (69)

Another case study of a similar patient “showed no clinical improvement,” but when the patient’s urine was tested, no ketones were detected, meaning she was probably not in a state of ketosis. (68)

One reason the keto diet may help manage manic depression is due to a similar sodium-lowering action of the keto diet, similar to the way lithium (a common manic depression drug) lowers sodium.

Five animal studies and two human reports have observed the impact of the ketogenic diet for autism, finding impressive results each time. While on the ketogenic diet, animals have markedly lower instances of behaviors common to that model of autism, such as social deficits, mitochondrial dysfunction, reduced sociability, communication, increased repetitive behavior, stress response deficits and microbiome issues. (70, 71, 72)

In children, one pilot study found that, of the children who were able to tolerate the diet, most of them showed “mild-to-moderate improvements” when rated on the Childhood Autism Rating Scale, and two children had “significant improvements.” (75)

A case study of a child with epilepsy and autism noted that the patient lost a significant amount of weight, showed improvements in both cognitive and behavioral symptoms of autism and dropped from a 49 to a 17 on the Childhood Autism Rating Scale, moving from a severely autistic rating to “non-autistic.” His IQ increased by 70 points and his seizures were completely gone after 14 months on the diet. (76)

Researchers have stated in a systematic review that, while they acknowledge the impressive results so far, there is not enough evidence yet to recommend this diet as a first-line treatment for autism. (77)

Only one research study, observing dogs, has been conducted comparing the keto diet to ADHD. These dogs all had epilepsy in addition to canine ADHD and all saw marked improvement in both conditions while on a ketogenic diet for six months. (78)

Precautions

The results we’ve seen here are promising in many ways and give hope for future research for schizophrenia natural treatment through the ketogenic diet for mental disorders. However, these are complex disorders and should be managed under the care of a qualified psychiatrist. Consult your psychiatrist and/or primary care provider before beginning a new dietary regimen of any kind.

If you currently take psychotropic drugs, you should discuss alternative remedies with your physician and never stop taking your medicine cold turkey without the explicit instructions of your healthcare provider.

There is not much known about the ketogenic diet during pregnancy, so it’s best to consult with your doctor in those cases.

Final Thoughts

Food is medicine — that much is clear. When it comes to the ketogenic diet and psychosis, the ketogenic diet and depression and even the ketogenic diet and mental disorders of many kinds, it seems that the research points toward an encouraging step in a healthy, diet-based direction.

Many researchers, doctors and psychiatrists are looking for novel methods of treating mental illness because of three major problems with conventional treatment of these disorders:

Psychoactive drugs aren’t as effective as you may think.
The side effects and other dangers of psychoactive drugs are very serious.
Scientists have studied many natural or alternative methods to treat mental illness that seem to work effectively.

Schizophrenia, a biologically occurring mental illness, is often debilitating and has little hopeful treatment methods. But one of the exciting schizophrenia natural remedies may be the ketogenic diet. This evidence is, so far, based on case studies and some animal research, so it’s exciting to await future clinical trials to see results for larger samples of human subjects — particularly since the ketogenic diet is a very safe, healthful approach to eating.

Other research suggests that those with anxiety, depression, manic depression, autism and ADHD may also benefit from a ketogenic diet, but these results still need to be replicated in larger trials, too.

Before changing your dietary regimen or changing your drug schedule, you should first consult with your physician. Do not self-treat, as the withdrawal symptoms and consequences of drastically altering drug or dietary regimens without the supervision of a doctor can be severe.